Abstract Details

Title Convexity Subarachnoid Hemorrhage in Cerebral Amyloid Angiopathy-related Lobar Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Recurrence Risk

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-017

Objective
To evaluate whether convexity subarachnoid hemorrhage (cSAH) in CAA-related lobar ICH predicts higher risk of recurrence, and to examine the impact of cortical superficial siderosis (cSS) on recurrence, mortality, and outcomes, identifying imaging markers such as CT-visible cSAH or disseminated cSS as predictors of hemorrhagic instability.

Background Cerebral amyloid angiopathy (CAA) is a leading cause of spontaneous lobar intracerebral hemorrhage (ICH) in older adults. Convexity subarachnoid hemorrhage (cSAH) and cortical superficial siderosis (cSS) represent imaging biomarkers of CAA-related vascular fragility and disease activity. Although both are increasingly recognized, their prognostic value for recurrent hemorrhage remains uncertain. This meta-analysis aimed to determine the association between cSAH and the risk of recurrent ICH in patients with CAA.

Design/Methods We systematically searched PubMed and Embase (1980–May 2025) for studies of adults (≥18 years) with CAA-related lobar ICH that reported recurrence outcomes by presence of convexity subarachnoid hemorrhage (cSAH) or cortical superficial siderosis (cSS). Eligible cohort and registry studies were analyzed using random-effects models to estimate pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Four studies including patients with CAA-related lobar ICH and imaging evidence of cSAH/cSS were meta-analyzed. The pooled risk of recurrent ICH was significantly higher in those with cSAH or cSS (pooled HR 2.67; 95% CI 1.86–3.84; I² = 0%). These findings demonstrate a robust and consistent association between superficial hemorrhagic markers and recurrent CAA-related bleeding.

Conclusions Convexity subarachnoid hemorrhage and cortical superficial siderosis strongly predict recurrent hemorrhage in cerebral amyloid angiopathy, identifying a high-risk subgroup for early rebleeding and disability. Integrating these imaging markers may enhance risk stratification and preventive care.

Authors/Disclosures
Sangharsha Thapa, MD PRESENTER	Dr. Thapa has nothing to disclose.
Anish Thapa, MBBS	Dr. Thapa has nothing to disclose.
Prateek Thakur (ALL INDIA INSTITUTE OF MEDICAL SCIENCES)	Mr. Thakur has nothing to disclose.
Sangam Shah (Tribhuvan University, Institute of Medicine)	Dr. Shah has nothing to disclose.
NIRAJ GAUTAM	No disclosure on file

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